TJ Fancy Enterprises LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

TJ FANCY ENTERPRISES LLC

Doing business as

Sterling Optical 131

Practice address

104 Kasson Rd Ste C
Camillus, NY 13031-2248

Phone

(315) 487-0327

Fax

(315) 487-4425

NPI assigned

Apr 25, 2024

Last updated

Apr 25, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tanya Grevelding

Title

Owner

Phone

(315) 418-2396

Specialties & licenses 1

Addresses

Other names 1

• Sterling Optical 131 Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1043066624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 KASSON RD STE C",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130312248",
            "telephone_number": "315-487-0327",
            "fax_number": "315-487-4425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 KASSON RD STE C",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130312248",
            "telephone_number": "315-487-0327",
            "fax_number": "315-487-4425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TJ FANCY ENTERPRISES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-25",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "GREVELDING",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-418-2396"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sterling Optical 131",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Camillus, NY
• Providers in Camillus, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.